Healthcare Provider Details

I. General information

NPI: 1073453619
Provider Name (Legal Business Name): ESMERALDA WELLNESS HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 THE GRN STE A
DOVER DE
19901-3618
US

IV. Provider business mailing address

8 THE GRN STE A
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 443-613-2173
  • Fax:
Mailing address:
  • Phone: 443-613-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TERESA ESMERALDA TICCHI
Title or Position: CEO AND FOUNDER
Credential: MSW LCSW-C
Phone: 443-613-2173